EVENING. Health.

Pox On Us, Lest We Forget

Recent outbreaks of disease around the United States bring to mind worse scourges of the past-the plague of Justinian, the Black Death and the Great Plague of London, for instance.

The world is periodically afflicted with scourges that take horrible tolls in life. But we forget about them because they occur only every century or so, and there is no one alive who remembers them. But there have been scourges throughout recorded history.

One was the plague of Ashdod, which occurred about 1000 B.C. and is described in the Old Testament. It is named after the city in which it broke out.

If you're searching for a reason for the downfall of the Roman Empire and the onset of the Dark Ages, blame not hedonistic lifestyles but the plague of Justinian, named after the Byzantine emperor at the time.

Justinian is famous for his many military conquests, but he could not conquer what struck his empire in the year 540: a bubonic plague that migrated from Egypt, borne by fleas clinging to rats. Traders and travelers carried the epidemic to Alexandria, then Palestine, then Constantinople, where it killed half the population.

Finally, the scourge spread throughout Europe, wiping out families and cities and depopulating whole regions until it subsided 50 years later. Death toll: Probably more than 100 million.

"A typical victim was seized with sudden fever, often waking in a pool of perspiration," writes Charles Panati in "Panati's Extraordinary Endings of Practically Everything and Everybody." "The cavalcade of symptoms was rapid. The first day the person could feel the hard nodules of buboes in the groin and armpit. By the second or third day the fever produced violent delirium. . . . A person who coughed and spit up phlegm died quickly, usually by the fifth day."

Plague can strike the body in three ways: bubonic, which causes swelling of the lymph nodes (buboes); pneumonic, in which the lungs are affected, and septicemic, in which the bacillus gets into the bloodstream.

Since plague is almost always fatal, if you're lucky you'll get the blood form and be dead before you have to suffer the agonies of the bubonic and lung forms.

Plague broke out again with a vengeance in the 1340s with the Black Death, so-called because the disease produced hemorrhages that turned its victims black. This time the disease ran rampant until about 1400. It killed about 40 million people, including about a third of the 4 million living in England. It brought social revolution: peasants who survived demanded more freedom and better wages.

Italy was hardest hit. Whole monasteries and cities were wiped out. Construction on the cathedral of Sina, which was intended to be the largest in the world, was halted. The ghostly attempt still stands.

Society was mystified as to what caused the outbreak. Some people blamed the Jews, and many were put to death. The medical faculty of the University of Paris determined that the outbreak was caused by a triple conjunction of Saturn, Jupiter and Mars in the 40th degree of Aquarius on March 20, 1345! Sin was blamed, and mass confessions were convened, serving to spread the disease.

Rats and fleas were not suspected at first, probably because they were so familiar.

The disease appeared again in the Great Plague of London (1664-65), killing some 70,000 people out of a population of 460,000.

The plague bacteria is still with us, and there are small outbreaks of the disease every now and then; an outbreak in San Francisco in 1907 killed 77. But these days plague is found mostly in Third World countries.

Antibiotic drugs such as streptomycin, tetracycline and sulfonamides, but not penicillin, are good against the plague bacillus.

There have been outbreaks of other diseases, some since controlled, some still with us, some that left and returned in a mutant form. There is AIDS, for which there is no known cure. And there are syphilis, malaria, tuberculosis and polio.

And flu. On the morning of March 11, 1918, a soldier named Albert Mitchell reported to the infirmary at Camp Funston, Kan. He had all the symptoms of flu: slight fever, sore throat, headache, muscular aches and pains.

Soon another soldier showed up, complaining of the same symptoms. By noon that day, 107 soldiers had reported sick, and within two days 522 were ill, some critically with a form of pneumonia. In seven days this illness, Spanish flu, had spread to every state in the Union.

The pandemic was almost as vicious as the Black Death in the toll it took over so short a time; in 18 months it killed 25 million people-almost three times more than the number lost in World War I, an event that helped exacerbate its spread.

In the U.S. alone, there were 20 million cases in one year-almost one in five people. Of these, about 550,000 died (some put the death toll at more than a million.) What made this flu bug particularly vicious was that it teamed up with pneumonia.

Writes Panati: "It was a pandemic of our own time, still remembered by survivors, and, most remarkably, caused by a usually mild flu bug that in the spring of 1918 went genetically berserk. The story is chilling and riveting, not merely for the mind-boggling death toll, but because it could easily happen again."